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December 14, 1984, Vol 252, No. 22 >
ARTICLE | December 14, 1984

Epidemic Non-A, Non-B Hepatitis in Nepal: Title and subTitle BreakRecovery of a Possible Etiologic Agent and Transmission Studies in Marmosets FREE

Mark A. Kane, MD; Daniel W. Bradley, PhD; Santosh M. Shrestha, MB, BS; James E. Maynard, MD, PhD; E. H. Cook, MS; Ram Prasad Mishra, ABMS; D. D. Joshi, MB, BS
[+] Author Affiliations

Reprint requests to Hepatitis Branch, Centers for Disease Control, Bldg 6, Room 154, 1600 Clifton Rd NE, Atlanta, GA 30333 (Dr Kane).


JAMA. 1984;252(22):3140-3145. doi:10.1001/jama.1984.03350220046029
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References

An epidemic of non-A, non-B hepatitis occurred in Kathmandu Valley, Nepal, during 1981-1982, with approximately 7.6% of households and 1.4% of individuals affected. Cases occurred preponderantly in the 15- to 34-year-old age group (70%), with most cases (75%) occurring in males. A high mortality rate (21%) occurred in pregnant women admitted to the hospital. No single water source was implicated, but epidemic peaks occurred during monsoon rains, and multiple opportunities for enteric transmission existed. One of eight patient stools examined by immune electron microscopy revealed aggregated, antibody-coated, 27-nm viruslike particles when convalescent serum samples were used as sources of antibody. Inoculation of two chimpanzees and four marmosets with a suspension of this stool resulted in elevated liver enzyme activity in three marmosets. Fecal excretion of 27-nm particles during the acute phase of disease (with temporally coincident antigen activity by radioimmunoassay) was observed in one marmoset, which also developed convalescent antibody against the particles in the original inoculum.

(JAMA 1984;252:3140-3145)

REFERENCES

1 +
Bradley DW, Maynard JE, Popper H, et al;  Posttransfusion non-A, non-B hepatitis: Physicochemical properties of two distinct agents . J Infect Dis 1983;;148:254-265.
2 +
Francis DP, Hadler SC, Prendergast TJ, et al:  Occurrence of hepatitis A, B, and non-A/non-B in the United States: CDC Sentinel County hepatitis study I . Am J Med 1984;; 76:69-74.
3 +
Wong DC, Purcell RH, Sreenivasan MA, et al:  Epidemic and endemic hepatitis in India: Evidence for a non-A, non-B hepatitis virus aetiology . Lancet 1980;;2:876-879.
4 +
Balayan MS, Andjaparidze AG, Savinskaya SS, et al:  Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route . Intervirology 1983;;20:23-31.
5 +
Schable CA, Maynard JE:  Serodiagnosis of acute hepatitis B virus infection by a modified competitive binding radioimmunoassay . J Clin Microbiol 1982;;16:973-975.
6 +
Bradley DW, Hornbeck CL, Cook EH, et al:  Purification of hepatitis A virus from chimpanzee stools . J Virol 1977;;22:228-231.
7 +
Krawczynski KZ, Bradley DW, Murphy BL, et al:  Pathogenetic aspects of hepatitis A virus infection in enterally inoculated marmosets . Am J Clin Pathol 1981;;76:698-706.
8 +
Gravelle CR, Hornbeck CL, Maynard JE, et al:  Hepatitis A: Report of a common source outbreak with recovery of a possible etiologic agent: II. Laboratory studies . J Infect Dis 1975;; 131:67-71.
9 +
Bradley DW, McCaustland KA, Cook EH, et al:  Dissociation of hepatitis A virus antigenanti-HAV antibody complexes by 2-mercaptoethanol and dithiothreitol . J Med Virol 1982;; 9:311-325.
10 +
Brandt CD, Kim HW, Rudriguez WJ, et al:  Comparison of direct electron microscopy, immune electron microscopy, and rotaviruses enzyme-linked immunosorbent assay for detection of gastroenteritis viruses in children . J Clin Microbiol 1981;;13:976-981.
11 +
Hillis A, Shrestha SM, Saha NK:  An epidemic of infectious hepatitis in the Kathmandu Valley . J Nepal Med Assoc 1973;;11:145-151.
12 +
Viswanathan R:  Certain epidemiological features of infectious hepatitis during Delhi epidemic, 1955-1956 , in Hartman FW (ed): Hepatitis Frontiers, Henry Ford Hospital International Symposium . Boston, Little Brown & Co, 1957;, pp 207-210.
13 +
Khuroo MS:  Study of an epidemic of non-A, non-B hepatitis: Possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type . Am J Med 1980;; 80:818-824.
14 +
Sreenivasan MA, Banerjee K, Pandya PG, et al:  Epidemiological investigations of an outbreak of infectious hepatitis in Ahmedabad city during 1975-1976 . Indian J Med Res 1978;;67:197-206.
15 +
Khuroo MS, Duermeyer W, Zargar SA, et al:  Acute sporadic non-A, non-B hepatitis in India . Am J Epidemiol 1983;;118:360-364.
16 +
Tandon BN, Joshi YK, Jain SK, et al:  An epidemic of non-A, non-B hepatitis in north India . Indian J Med Res 1982;;75:739-744.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Bradley DW, Maynard JE, Popper H, et al;  Posttransfusion non-A, non-B hepatitis: Physicochemical properties of two distinct agents . J Infect Dis 1983;;148:254-265.
2 +
Francis DP, Hadler SC, Prendergast TJ, et al:  Occurrence of hepatitis A, B, and non-A/non-B in the United States: CDC Sentinel County hepatitis study I . Am J Med 1984;; 76:69-74.
3 +
Wong DC, Purcell RH, Sreenivasan MA, et al:  Epidemic and endemic hepatitis in India: Evidence for a non-A, non-B hepatitis virus aetiology . Lancet 1980;;2:876-879.
4 +
Balayan MS, Andjaparidze AG, Savinskaya SS, et al:  Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route . Intervirology 1983;;20:23-31.
5 +
Schable CA, Maynard JE:  Serodiagnosis of acute hepatitis B virus infection by a modified competitive binding radioimmunoassay . J Clin Microbiol 1982;;16:973-975.
6 +
Bradley DW, Hornbeck CL, Cook EH, et al:  Purification of hepatitis A virus from chimpanzee stools . J Virol 1977;;22:228-231.
7 +
Krawczynski KZ, Bradley DW, Murphy BL, et al:  Pathogenetic aspects of hepatitis A virus infection in enterally inoculated marmosets . Am J Clin Pathol 1981;;76:698-706.
8 +
Gravelle CR, Hornbeck CL, Maynard JE, et al:  Hepatitis A: Report of a common source outbreak with recovery of a possible etiologic agent: II. Laboratory studies . J Infect Dis 1975;; 131:67-71.
9 +
Bradley DW, McCaustland KA, Cook EH, et al:  Dissociation of hepatitis A virus antigenanti-HAV antibody complexes by 2-mercaptoethanol and dithiothreitol . J Med Virol 1982;; 9:311-325.
10 +
Brandt CD, Kim HW, Rudriguez WJ, et al:  Comparison of direct electron microscopy, immune electron microscopy, and rotaviruses enzyme-linked immunosorbent assay for detection of gastroenteritis viruses in children . J Clin Microbiol 1981;;13:976-981.
11 +
Hillis A, Shrestha SM, Saha NK:  An epidemic of infectious hepatitis in the Kathmandu Valley . J Nepal Med Assoc 1973;;11:145-151.
12 +
Viswanathan R:  Certain epidemiological features of infectious hepatitis during Delhi epidemic, 1955-1956 , in Hartman FW (ed): Hepatitis Frontiers, Henry Ford Hospital International Symposium . Boston, Little Brown & Co, 1957;, pp 207-210.
13 +
Khuroo MS:  Study of an epidemic of non-A, non-B hepatitis: Possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type . Am J Med 1980;; 80:818-824.
14 +
Sreenivasan MA, Banerjee K, Pandya PG, et al:  Epidemiological investigations of an outbreak of infectious hepatitis in Ahmedabad city during 1975-1976 . Indian J Med Res 1978;;67:197-206.
15 +
Khuroo MS, Duermeyer W, Zargar SA, et al:  Acute sporadic non-A, non-B hepatitis in India . Am J Epidemiol 1983;;118:360-364.
16 +
Tandon BN, Joshi YK, Jain SK, et al:  An epidemic of non-A, non-B hepatitis in north India . Indian J Med Res 1982;;75:739-744.

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